Online Health Chat with Jeff Chapa, MD

Wednesday, December 3, 2014


Description

Pregnancy-related complications affect many women regardless of age or race. Health issues can involve the mother, the baby or both, and may occur before pregnancy, during pregnancy or after giving birth. Pre-existing medical conditions such as diabetes, high blood pressure, heart disease, kidney disease and lupus increase the risk of complications during pregnancy and need to be well managed. Complications such as preterm labor, preeclampsia and gestational diabetes can be very stressful and emotionally challenging. Your baby may also have health concerns that are detectable prior to birth. It is important to understand when to contact your doctor or midwife if something is bothering you.

Pregnancy-related problems may be rare or common. They can be considered a mild concern or a significant risk to your or your baby’s health. Fortunately, there are a number of prenatal tests that can detect or prevent complications, and there are ways to manage pregnancy complications. It begins with recognizing there is a problem and working together as a team with your health care provider to manage it and assure there is less risk for you and your baby.

While many hospitals have units that cater to at-risk infants, the Special Delivery Unit at Cleveland Clinic's main campus is the first unit of its kind built to accommodate pregnant women in extremely critical condition, as well as their newborns.


About the Speaker

Jeff Chapa, MD, is Head of the Section of Maternal-Fetal Medicine at Cleveland Clinic’s Ob/Gyn & Women’s Health Institute and is board certified in obstetrics and gynecology, maternal-fetal medicine and medical genetics. Dr. Chapa earned his medical degree from St. Louis University School of Medicine. His post-graduate training includes an obstetrics and gynecology residency at University Hospitals of Cleveland and Case Western Reserve University in Cleveland followed by a three-year maternal-fetal medicine fellowship at the University of Chicago. He also completed a two-year medical genetics fellowship at the University of Chicago and Children’s Memorial Hospital.

Dr. Chapa is a member of the American College of Obstetricians and Gynecologists as well as the Society for Maternal-Fetal Medicine. He won a research award from the Cleveland Ob/Gyn Society in 2000. He has published multiple research articles in peer-reviewed journals, as well as having contributed abstracts and presentations at a number of professional association meetings. His specialty interests include preconception counseling, comprehensive management of high-risk pregnancies, obstetrical ultrasound and prenatal diagnosis, and prenatal genetic counseling.


Let’s Chat About: Pregnancy Complications


Birds and Bees

Kenzie1234: If I'm nine weeks pregnant, I had sex around seven weeks ago, correct?

Jeff_Chapa,_MD: Yes. Most likely, you conceived around seven weeks ago.

Raphosody: What types of conditions make doctors consider a pregnancy “high risk”, and when should an OB consult a specialist?

Jeff_Chapa,_MD: The three broad categories are:
1. Fetal abnormalities, such as birth defects or other conditions affecting the baby
2. Pregnancy-related complications, such as gestational diabetes, preterm labor or preeclampsia
3. Medical conditions in the mother, such as hypertension, diabetes or heart disease

Margaret: When is it safe to start the exercise program that you suggest I do? I have not really ever been an athletic person, so is this something I can do while pregnant, or should I start before getting pregnant? Can you give some suggestions of what I can do?

Jeff_Chapa,_MD: It’s OK that you have not been athletic before. Ideally, it is best to start prior to pregnancy. You can start with walking or jogging and build up as you go. Many patients like to use machines such as an elliptical, and that would be good. Swimming is also good, if you have access to a pool. Getting started is often the hardest part, but it can make a huge difference for you. Good luck.

saravanan2008: Hi doctor. I have ejected my sperm fully on my wife’s vaginal opening and fingered her for the last two days. Within a minute, 80 percent of the sperm got inside. Is there a chance of pregnancy? She is in her ovulation period.

Jeff_Chapa,_MD: It is possible. Wait a couple of weeks and see if she misses her period.


Concurrent Conditions

sameer: My wife is suffering from a brain tumor and its effect on her bone marrow. No medicines are affecting her. If she gets pregnant, then can be she fine? Can she regenerate the bone marrow?

Jeff_Chapa,_MD: I would probably avoid getting pregnant until your wife’s medical condition is stable and her bone marrow is functioning. Pregnancy can be a significant strain for the body, and can lead to worsening of her health if she is not well to begin with. It is best to consult with your personal physician.

Sher31: I have high blood pressure. What are my options for continuing to manage my symptoms, and what effect will this have on my baby?

Jeff_Chapa,_MD: There are a number of medications that can be used safely to control your blood pressure during pregnancy, and your blood pressure should be followed closely by your doctor. The risks from high blood pressure include smaller babies (growth restriction) and early delivery due to the development of preeclampsia, a pregnancy-related blood pressure complication.

RoobbieDo: I have PCOS (polycystic ovarian syndrome) and have finally been able to conceive. Does polycystic ovary disease cause problems during pregnancy and if so what?

Jeff_Chapa,_MD: Congratulations! Most people with PCOS do well. You may be at an increased risk for gestational diabetes and the development of preeclampsia. Your doctor should screen for this and follow you closely. Good luck.

Charleston: I have IBS (irritable bowel syndrome) and have struggled with it for years; and, because of this, my diet is pretty restricted. What can I do to make sure that my baby is getting all of the necessary nutrients that it needs while I'm pregnant?

Jeff_Chapa,_MD: Try to be as balanced with your diet as you can be. Also, take a prenatal vitamin and a supplement with iron if you are anemic. Most babies do fine, even with very restrictive diets.

DMH73: I was diagnosed with systemic sclerosis (an autoimmune disorder) more than 13 years ago. If I was to get pregnant, what problems should I look out for or possibly expect? Should I see a high-risk pregnancy doctor and how soon after getting pregnant?

Jeff_Chapa,_MD: It depends on how you are doing with your condition and if you have issues with any of your organs such as your heart, blood vessels and kidneys. I would see a high-risk pregnancy doctor prior to getting pregnant, so that we can help you have the best possible outcome.


Concerning Complications

Conrad: A friend of mine had placenta previa, but I don’t quite understand what that means and how it happens. Can you explain this?

Jeff_Chapa,_MD: Sure. It means that the placenta implants over the cervix. This blocks the path for the baby to deliver and leads to an increased risk for bleeding, which can be quite serious. Patients with this condition must be followed closely and delivered by cesarean section, as vaginal delivery is not possible due to the bleeding risk.

germaine: What is preeclampsia? What are the symptoms? What causes it and is there anything that puts women at a higher risk for developing preeclampsia?

Jeff_Chapa,_MD: Preeclampsia is a blood pressure complication that generally occurs in the third trimester. It is characterized by high blood pressure, protein in the urine and swelling all over the body. It is thought to result from the abnormal implantation of the placenta. Common symptoms of preeclampsia include headache, blurry vision, spots in your visual field, swelling all over your body and sometimes upper abdominal pain. Patients with pre-existing high blood pressure or other medical problems such as kidney disease are at greater risk. Also a history of preeclampsia puts you at greater risk in a future pregnancy.

Melissa: Can you do anything to prevent preeclampsia in a future pregnancy?

Jeff_Chapa,_MD: Yes, you can take low-dose aspirin during a future pregnancy to reduce the risk for recurrence. This is particularly important if you had preeclampsia early in the prior pregnancy.

Margaret: Can you do anything to prevent pre-term births?

Jeff_Chapa,_MD: Yes. If you went into labor on your own and delivered prematurely, taking weekly progesterone injections can decrease your risk to deliver prematurely again. Also, in some cases, if there is an issue with your cervix, placement of a cerclage or suture to close the cervix can help.

letluvbe: What is hyperemesis gravid arum, and if you have it during one pregnancy, are you likely to experience it again with subsequent pregnancies? How is it managed?

Jeff_Chapa,_MD: Hyperemesis gravid arum is nausea and vomiting during early pregnancy due to pregnancy-related hormones leading to metabolic changes, weight loss and dehydration. Yes, it can recur in up to 2/3 of women. Treatment consists of lifestyle changes, medications to treat nausea and supportive care such as IV fluids. It typically gets better after the 1st trimester.

Adele: I had gestational diabetes during my first pregnancy. Is it possible for it to come back during this pregnancy? Are there any steps that I can take to avoid this?

Jeff_Chapa,_MD: Yes, there is an increased chance for it to come back. You can start a program of regular exercise, diet and weight loss, which can reduce your risk for gestational diabetes during a future pregnancy.


Harrowing Happenings

Setman28: What are the symptoms of having a miscarriage, and why do miscarriages generally occur?

Jeff_Chapa,_MD: Miscarriage occurs in about 20 percent of all clinically recognized pregnancies. The most common signs are vaginal bleeding and abdominal cramping, which can also be experience during many normal, healthy pregnancies. The most common reason for a miscarriage is a chromosome abnormality in the pregnancy. Other reasons include abnormalities in the uterus, drug use including tobacco and alcohol, a deficiency of progesterone in early pregnancy (luteal phase defect) and medical diseases in the mother. Often, we don't know why miscarriages happen.

Ash89765: I just found out last Saturday that I'm pregnant. The first day of my last period was Oct.22, 2014! I just went to the bathroom and there was a SLIGHTLY pink color on the toilet paper. I have one other child who is 3, and I had no pregnancy problems. Should I be worried?

Jeff_Chapa,_MD: Congratulations. Bleeding and spotting are very common in early pregnancy. Although miscarriage often has bleeding and cramping, this is also found in many healthy pregnancies. I would follow-up with your doctor for an ultrasound to check on the pregnancy.

MichaelAnne: I am having cramping and I do not know if this would be considered as pre-term labor? What should I be concerned about?

Jeff_Chapa,_MD: Cramping can be normal in many situations due to the uterus getting bigger. Preterm labor is due to contractions leading to cervical dilation. Contractions most often are described as a tightening across the belly. Often, your belly will feel very hard when you are having a contraction. Generally, if you are under 34 weeks, we recommend that you call your doctor is you have more than four to six contractions per hour. Also, vaginal bleeding and leakage of fluid can be signs of labor and are reasons to call your doctor.


Infectious Inquiries

BenJen2012: I have a couple of cats and recently changed the litter before I realized I was pregnant. Now I have read that toxoplasmosis can be caused by cat feces. Should I be concerned? What are the symptoms of toxoplasmosis? Is it like the flu? How do you know the difference? What does it do to the baby? Sorry for all of these questions, but I am a little freaked out.

Jeff_Chapa,_MD: Toxoplasmosis infection is rare, so you most likely will be fine. It can occur from handling feces of an infected cat or, more commonly, from eating raw or under-cooked meat. In most cases, there are no symptoms in the mother; but in some cases, it can present with flu-like symptoms. There are blood tests to see if you have recently been infected or if you have prior exposure, which would give you immunity and prevent infection in the baby. Going forward, you should avoid changing the cat litter, and wash your hands after handling your cat. I would also keep your cat inside and away from animals such as mice, which could be infected. Finally, cook all meat well before eating. I hope this helps and you feel better about your situation.

Heather: Should I get a flu shot if I am pregnant? If I don't get a flu shot and then get the flu, what are the risks to the baby?

Jeff_Chapa,_MD: We recommend all pregnant women get the flu shot. There are no known risks to the baby from the vaccine. If you get the flu when you are pregnant, it can be very severe, leading to early delivery or miscarriage. Some pregnant women get very ill and can even die from flu.

laurenlovesjosh1: I have a white blister on the left side of my labia, which is very painful, and I am 22 weeks pregnant. I have been with the same man for 11 months.

Jeff_Chapa,_MD: You should have your doctor look at the blister. It could be anything from an infected or blocked hair follicle to a sexually transmitted disease. I cannot be sure without an examination.

tanny: I had chlamydia prior to getting pregnant, but did not even know it because I did not have any symptoms. If it was treated, will everything be okay with my pregnancy?

Jeff_Chapa,_MD: Yes. You should be treated and then checked for chlamydia again later to make sure the infection has gone away. It would also be good for your partner to be treated; otherwise, it could come back if you have unprotected sex with your partner.

celly: I tend to get a lot of urinary tract infections? What if I get one when I am pregnant?

Jeff_Chapa,_MD: You are at an increased risk during pregnancy, and there is a greater likelihood for it to spread to one of your kidneys. Therefore, you should be screened frequently for urinary tract infections with periodic urine cultures. If you get more than one during pregnancy, often your doctor will put you on a daily antibiotic to prevent further infections.

21pulllots: If I have a herpes outbreak during pregnancy will this affect the baby?

Jeff_Chapa,_MD: It could if the baby delivers vaginally and you have active lesions. Generally, we recommend treatment in the third trimester for people with a history of genital herpes to prevent outbreaks around the time of delivery.


Nutrition Notions

gayathri1989: I am three months pregnant now, and I have completely avoided consuming high-mercury seafood from the day my pregnancy was confirmed. I used to eat king mackerel on a rather regular basis almost three months prior to pregnancy. Will this cause any harm to my baby.

Jeff_Chapa,_MD: You should be fine. Just continue what you are doing. I would also avoid shellfish and raw fish during your pregnancy.

Sallie: I follow a strict vegan diet. Is this a problem during pregnancy?

Jeff_Chapa,_MD: No, you should make sure you have good sources of protein, which can be found in many vegetables such as beans.

Margaret: Thank you for your response. Are there any other foods that I should avoid while pregnant aside from shellfish and raw fish? I feel like there are some misconceptions out there about what you can and can’t eat.

Jeff_Chapa,_MD: Avoid uncooked or raw meat. Also avoid certain types of cheeses and dairy products that are not pasteurized. You can always check with your grocer about this.


Problem Possibilities

Lisa: What are our risks in having a child with a congenital heart defect if it runs in the family?

Jeff_Chapa,_MD: The general population risk for congenital heart defects is about eight per 1000 (so less than one percent). If there is a strong family history, the risk would be somewhat higher (two percent to five percent in most cases), depending on the type of defect and the number of affected people in your family. Seeing a genetic counselor prior to getting pregnant could help give you a better idea of your own personal risk.

Lisa: How are congenital heart defects detected? And if one is detected, what are the next steps?

Jeff_Chapa,_MD: They are usually detected with ultrasound. The next steps include speaking with a pediatric cardiologist and, in some cases, a heart surgeon to plan for the care of the baby after birth. Sometimes, heart defects are associated with other genetic conditions, so genetic counseling and testing is sometimes also recommended.

Colleenn: I am turning 38 this summer and my husband and I hope to start a family. I have heard that women over the age of 35 have a hard time conceiving, and they also have an increased risk of having a child with Down syndrome. Are there any suggestions that you have for me to help make sure that I have the healthiest baby possible?

Jeff_Chapa,_MD: You should have a great chance to have more than one successful pregnancy. Yes, fertility rates decline, but this really becomes more of an issue after the age of 41 to 42. The risk for chromosome abnormalities is around two percent to three percent, with Down syndrome being the most common at one percent to two percent. We now have tests that can screen for and detect these conditions very early in your pregnancy. The best thing you can do for yourself is to get into shape for your pregnancy – eat healthy and exercise regularly. Start taking a prenatal vitamin. Good luck!

MSmnu: I have heard about a new blood test that you can have while pregnant that checks for chromosomal abnormalities. Are there any restrictions as to who can get this test done?

Jeff_Chapa,_MD: Yes. Currently, this test is reserved for women with added risk factors for chromosome abnormalities, such as age > or = to 35, previous child with chromosome abnormality, abnormal screening test or ultrasound abnormalities.


General Information

sra: Regarding fetal surgery, what kinds of problems can be addressed during pregnancy? Is this something done at Cleveland Clinic?

Jeff_Chapa,_MD: Fetal surgery has been mainly used for specific birth defects such as spina bifida, certain heart defects, diaphragmatic hernia and various types of growths/tumors in unborn babies. Often, it is for the most severe cases where there are no other options for treatment. There are only a few places across the country that offer this. We do not offer this but can refer patients to the appropriate places.


Closing

Moderator: That is all the time we have today for questions. Thank you everyone for participating today; and thank you, Dr. Chapa, for your insightful answers to our questions about pregnancy-related complications.

Jeff_Chapa,_MD: Thanks for all your questions. Remember, planning for your pregnancy can be a big help, particularly if you have medical conditions or other risk factors for pregnancy-related complications. Good luck!


For Appointments

To make an appointment with Dr. Jeff Chapa or any of the other specialists in Cleveland Clinic’s Ob/Gyn & Women’s Health Institute, please call 216.444.6601 or 800.223.2273, x 4-6601. You can also visit us online at clevelandclinic.org/obgyn.


For More Information

On Cleveland Clinic

Cleveland Clinic’s Ob/Gyn & Women’s Health Institute is designed to meet the unique and changing medical needs of women from adolescence to mature adulthood. Our team offers coordinated and supportive care for the programs that affect women’s lives, from infertility, incontinence, gynecologic cancers, pelvic floor disorders, menopause and more. We are committed to providing world-class care to women of all ages. Services are available on the main campus, as well as in family health centers and hospitals throughout the region.

In 2014, the Department of Obstetrics and Gynecology was the top-rated program in Ohio and ranked number three nationally by U.S. News & World Report.

On Pregnancy - Health Information

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